Disease detectives

By Erin McClam

Associated Press

ATLANTA – She had already missed her brother’s wedding. That happened in the weeks after Sept. 11, when the Centers for Disease Control and Prevention sent her to Washington.

Jennita Reefhuis’ assignment then was to monitor hospital data, hour by hour, for any suspicious outbreaks – the earliest signs of possible bioterrorism.

Now she was home again in Atlanta, dealing with a heap of dirty laundry and ready to return to her normal work – trying to spot new causes of birth defects.

Then the phone rang. It was Doug Hamilton, chief of the CDC’s epidemiologists. He told her about a strange case of anthrax – the first U.S. case of the disease in a quarter-century. No one in the public knew about it. “You’re going to Florida,” the boss said.

So Reefhuis packed a bag and told her fiance she was going away. She couldn’t tell him where, or why, or even how long she would be gone. Even she didn’t know that.

Reefhuis, 29, is part of the government’s Epidemic Intelligence Service – 146 disease detectives, mostly in their 20s and 30s, some of them medical doctors, others public health specialists.

In Florida, New York, New Jersey, Washington and now Connecticut – where eight EIS officers are trying to find out how a 94-year-old woman was sickened – the medical sleuths have fanned out to solve the anthrax mystery.

Most of the officers are based in Atlanta, but they have been pulled from assignments in more than a dozen states, off projects ranging from AIDS to health statistics.

It began in early October, when a tabloid newspaper editor contracted inhalation anthrax, the first U.S. case since 1976. In the first days, the case appeared to be isolated.

“Right away we were all perplexed and fascinated,” said Dr. Pratima Raghunathan, who was sent to Florida in early October. They were immediately suspicious that it might be bioterrorism, she said, “but everyone kept an open mind. I was dying to go.”

And go she did, gathering clues at American Media Inc. until 4 a.m. that first night, examining the building and talking to FBI agents.

For the next two weeks, Reefhuis and Raghunathan were two of about a dozen CDC disease detectives trying to solve the baffling Florida anthrax puzzle.

They quizzed employees of the tabloid for hours at a time: Where did they work? Who sat nearby? What paths did they take through the building each day? How did the mail flow?

They used blueprints of the sealed building to try to reconstruct where the anthrax might have been released. And they dispensed antibiotics to thousands of tabloid employees in case they were exposed.

Reefhuis was stationed in Tallahassee. Hour by hour, she scanned disease reports from hospitals all over the state. Anything out of the ordinary would raise a flag, maybe even signal more anthrax.

Both women found themselves in unexpected dual roles. They were gathering information, but they provided information, too, to comfort ordinary citizens and doctors alike, many uninformed – and scared.

Back in Atlanta, Reefhuis told her fiance she was probably home for good.

“I’m very good at denial,” she said.

It was mid-October, and Dr. Scott Harper was back to the flu.

After three weeks in New York, where he watched for bioterrorism after the World Trade Center crash, he was catching up on his work – projecting how influenza might look in this country three decades from now.

Harper is a 36-year-old infectious disease specialist close to finishing the two-year EIS program. He was already familiar with leaving his wife of 12 years and 2-year-old daughter on a day’s notice to track a disease.

When a suspicious letter was opened in the office of Sen. Tom Daschle, Harper was in Washington by coincidence, attending unrelated meetings. His hotel room phone jarred him awake at 3 a.m. It was Doug Hamilton.

“This is your wakeup call, Dr. Harper,” the boss said.

So Harper spent the next several days at the Capitol, interviewing Daschle staffers who had handled the anthrax-laden letter. Hunched over maps of offices, he tracked how the bacteria might have reached congressional aides.

He was struck by exactly who was at risk – college students, interns, the people who do the menial work of the federal government. They were confused, and frightened. They asked questions like: Am I going to get it?

“You never really think about who it is that does these sorts of things,” he said. “We played such a large role in answering questions, just calming people down.”

Then Washington postal workers started getting sick – four of them, two fatally, with inhalation anthrax. Anthrax had also shown up at four New York media outlets. In Washington, the investigation took on new urgency.

Harper raced to hospitals to interview anthrax patients. In Virginia State Patrol cruisers, he rushed blood cultures to the airport, putting them on planes to Atlanta, where the CDC’s new 24-hour anthrax lab was furiously conducting tests.

New anthrax cases seemed to pop up every day. In the few spare moments, over cold dinners at 11 p.m., Harper and his colleagues reflected on what was happening.

“We still didn’t have good information about how it was released. This could have been the tip of the iceberg,” he said. “People weren’t sure about how long they were going to be there, how many more cases there might be.”

At his home in the Atlanta suburb of Decatur, Dr. Reuben Varghese kept a bag packed. A 36-year-old internist by training, he was working on a program to boost cancer screening rates for employees of General Motors.

He had already been to New York in the days after the terror attacks. Now he was going to New Jersey where the skin form of anthrax had surfaced.

Leaving meant putting his dog in a kennel and reassuring his nervous mother, who worried that he would get anthrax himself. He reminded her the disease detectives were given antibiotics, just in case.

He landed in Trenton the next day.

In New Jersey, Varghese mimicked some of the work his colleagues had developed for New York, Washington and Florida: He kept an eye out for bioterroism, dispensed batches of antibiotics, calmed fears.

Sometimes, he told hospital workers he had no answers.

Jennita Reefhuis was there, too. On Oct. 18, she had agreed to go to New Jersey, but she told Hamilton she wanted to be home in a few days to celebrate an anniversary with her fiance.

The boss told her she might be home in time, and she believed him, because she has learned she is good at denial. She wound up spending two weeks – and missing the anniversary.

Reefhuis immersed herself in the New Jersey mail, obsessively tracking how a letter travels through the system. She checked nasal swabs for anthrax and handed out questionnaires to dozens of postal workers.

In all, five people in New Jersey got anthrax. Reefhuis and Varghese returned to Atlanta confident they had given out enough drugs to prevent new cases.

Still, they were frustrated. Now they seemed to know everything about how anthrax was being spread. But no one knew why.

Back in Washington, Scott Harper was eager to get home. He had spent two weeks in the Capitol. Now, the steady stream of new exposures and new anthrax cases had stopped.

At night, he called Atlanta to talk to Chloe, his 2-year-old. Harper has traveled as far as Uganda in his work with the CDC. Every time he goes away, he faces the same question, from his daughter or his wife: They always want to know when he is coming home.

“I’d have to say I’m not coming home tonight, and I’m not sure when I will,” he said. “No matter how far it is, it’s still the hardest thing.”

When he went home to Atlanta, he had no time to rest. There was a mountain of anthrax data, and he tried to find things the inhalation cases had in common.

There was also the flu vaccine work he had left behind in the first place. And he kept expecting the phone to ring again.

“It’s changed the way we look at our jobs,” he said. “We don’t think it’s over. Our sense of vigilance has increased, and there is this bit of tension. It sits on the front of everybody’s minds.”

In the latest wave, eight EIS officers were sent to Connecticut after the anthrax death of 94-year-old Ottilie Lundgren, who had no apparent connection to the media, the government or the mail.

Just like before, the team in Connecticut is handing out antibiotics, testing samples and poring over hospital reports.

Hamilton, the EIS director, pulled most of the new team from nearby states. Despite the decline in cases, no one believes the threat is over.

“Things have slowed down,” Hamilton said. “But they know the call’s coming.”

Raghunathan has put a study of meningitis on hold for now. As the Connecticut case deepens the anthrax mystery, she cannot imagine a day when anthrax will not be part of her work.

“I can’t see a day when we’ll stop,” she said. “We may re-balance, or re-prioritize. But I don’t think we’ll ever stop.”